Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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Research (102 posts)  RSS

New Research On Ductal Carcinoma In Situ (DCIS) Brings Knowledge--Now We Need Understanding

by Dr. Len August 21, 2015

It has been said that with knowledge comes understanding.

A research paper and editorial published in this week's issue of JAMA Oncology may have brought knowledge, but if you read various media reports I am not so certain it has clarified understanding. And the distinction is important, because when a woman is confronted with the diagnosis of a "Stage O" breast cancer (aka ductal carcinoma in situ or DCIS), the decisions she makes about treatment can have far-reaching and long lasting impact for her and those who care about her. More...

Genomic Testing Reaches The Clinic: How Much Is Hope--And How Much Is Hype?

by Dr. Len August 10, 2015

(The following blog was originally posted on MedpageToday on August 3, 2015. It is reprinted here with permission.)

 

Genomics and its impact on clinical medicine appear to be the topics du jour. The science is rapidly advancing, but our ability to understand and apply that science may not be keeping pace. The question is whether expectations will meet the promise, and are we wise enough to navigate the maelstrom and bring true benefit to our patients and consumers in general?

Three recent research reports highlight how fast some of this discovery is moving. Two reports focused on the use of cell-free DNA fragments extracted from the blood and saliva to identify cancer related markers in patients with pancreatic and head and neck cancer. The other reported discordance in DNA from mothers and their fetuses discovered when prenatal blood tests were done, again using cell-free DNA. In short, the researchers reported on situations where a prenatal screen showed abnormal DNA, the fetus was tested and showed normal DNA which then led to the discovery of cancer in the mother.

To be certain, there are many similar research reports. But they all point in the direction that we are soon going to be facing the challenge of determining how to apply this technology to the everyday practice of medicine, and cancer care specifically. The reality -- as emphasized in the reports -- is that this is early stage science, and not ready for prime time. But the question remains: will others try to exploit these findings and make claims beyond what the science will support?

The question is not so far-fetched. It is happening already.More...

Genomics May Be The New Frontier, But Knowing Your Family Medical History Is Still Very Important

by Dr. Len July 29, 2015

It's no secret that genomics is cutting edge science. It is exciting, it is changing the way we think about ourselves and the medical care we receive. But with all the "gee whiz" aspects of what we are discovering every day about our genetic code, it may be surprising to learn that one of the most important parts of our new tool kit may be sitting right there in front of us gathering more dust than attention.

This revelation came while attending a conference this past week sponsored by a group called HL7. HL7 develops standards for the exchange, integration, sharing, and retrieval of electronic health information in the healthcare setting. They convened this particular meeting to better understand how we can more effectively integrate genomic data into health care delivery and research so we can full advantage of the information from genomic-derived science that is coming at us like a tsunami. 

What stood out amidst all of the topics discussed-and what achieved the greatest consensus among the conferees-was the role that the tried-and-true basic family history can play in helping us understand how the information provided by genomics fits together with real life. That's correct: the old fashioned family history that you occasionally fill out in the doctor's office that neither you nor your health professional usually pay much attention to.

Perhaps that needs to change.More...

Meeting A Stem Cell/Bone MarrowDonor Reminds Me About Ordinary People Doing Something Extraordinary

by Dr. Len July 19, 2015

As I have mentioned previously, I travel quite a bit. And sometimes during those trips something interesting and unexpected can happen. That was the case a couple of weeks ago, when I was on a flight from Atlanta to Washington. And it impacted me in a way I could not have anticipated.

The flight was routine. Sitting next to me was a young man, likely in his 30's, sitting next to someone he was obviously related to and quite a bit older. It was clear he was pretty excited about the trip, and I couldn't help but overhear him say this was one of his first travels on an airplane.

I had a bit of work to do to prepare for a conference the next day, so I wasn't particularly chatty during the flight. But I thought the older gentleman sitting next to the window could have been a veteran (which it turns out he was). Having been present when a number of the Honor Flights returning from Washington to Chicago on a Friday night at Midway Airport (when we usually get into town for a medical meeting), I was aware that a lot of veterans have never seen the monuments and museums in Washington celebrating their service. So, I made the assumption that such was the case: the younger man was accompanying the older gentleman to see the sights.

As we landed and I put my work away, I thought I could give them a bit of a tour of what they were seeing as we landed in DC (yes, I have taken the flight too many times). So I asked them if my assumption was correct about the reason for their trip. And, to my surprise, I was wrong. More...

Some Of The Answers To Cancer Care May Be Found With Our Companion Dogs Walking Right Beside Us

by Dr. Len June 10, 2015

Fate can work in mysterious ways.

A couple of months ago I was invited to participate in a symposium conducted by the National Cancer Policy Board at the Institute of Medicine in Washington DC. The topic was cancer in dogs, and how we might find ways to benefit dogs, their owners and science to better inform the treatment of cancer in humans through what is called "comparative oncology".  It was an unusual topic in my experience and that of my colleagues, so I eagerly anticipated learning about something I hadn't given much consideration to in the past.

Little did I know at the time how personal this journey was going to be for me and my family.

Shortly after I accepted the invitation, we received sad news: our Golden Retriever Lily-who has been a member of our family for 11 years-developed swelling in her face. Our vet saw her the next day and told us she had lymphoma. The outlook without treatment wasn't good, and with treatment wasn't much better.  

Tears flowed in our home that evening.

A week later we found a mass on Lily's back leg. Another trip to the vet, another needle biopsy, and another cancer, this time a sarcoma. The prognosis was even worse. Lily likely had weeks to live.

Lily fortunately didn't suffer, and died peacefully last week.  Our local vet and my newly acquainted veterinary oncologists from Purdue (who were part of the conference faculty) became our trusted guides through a journey about which we knew precious little.

And now I found myself offering a presentation as the last speaker at the symposium, discussing our journey and what I have learned from the conference. Getting past the tears of our loss wasn't easy. More...

The Survivors And Advocates Highlight That Personalized Medicine Is About All Of Us

by Dr. Len June 02, 2015

When it comes to personalized/precision medicine we should never forget it's all about the people, particularly the cancer survivors whose very lives depend on us getting it done quickly and getting it right.

That was the message from a discussion I had the privilege to moderate  on Monday evening with cancer survivors and representatives of advocacy organizations, professional associations, government agencies, and industry at a session held in conjunction with the annual meeting of the American Society of Clinical Oncology (ASCO),  now wrapping up in Chicago.

There has been an incredible amount of big science presented at this meeting that relates very directly to the care we provide cancer patients. Some of that science has immediate application to cancer care. On several occasions, acknowledged experts opined in front of thousands of physicians, other scientists, and health professionals that new treatments-particularly immunotherapy-were new standards of care in the management of patients with certain cancers.

Running in parallel to the development of new approaches to the treatment of cancer is the science that is helping to define and personalize which patients would benefit most from which treatments. As an example, for the new immunotherapy drugs there are biomarkers that may eventually predict who is going to respond better to which medicine. And frequently during the research presentations there was evidence that the more a cancer cell had mutated the more likely it was to respond to these new drugs.

But it was the survivors who touched my heart, my thoughts and my hopes.More...

Advancing The Tenet That In Cancer Care We Need To Embrace Curing When We Can And Comforting Always

by Dr. Len May 29, 2015

It was the title of an article in JAMA Oncology that captured my attention this past week: "Advancing a Quality-of-Life Agenda in Cancer Advocacy: Beyond the War Metaphor." That and, the fact that two of the authors (Rebecca Kirch and Otis Brawley) are my colleagues from the American Cancer Society.

As the American Society of Clinical Oncology (ASCO) convenes its annual scientific meeting in Chicago--where thousands of participants from around the world gather to learn about the latest advances in cancer research and treatment--we should not lose sight of the fact that the quality of life for patients during cancer treatment and survival is a critical part of what we must address as part of a holistic approach to the cancer care paradigm.

For decades cancer prevention and treatment has focused on the war metaphor: fight cancer, beat cancer, fight hard, whatever. The reality is that not infrequently people do everything right and they still die from this dread disease. Does that mean they didn't fight hard enough? I don't think so, and I suspect many of you agree.

But there is a yawning gap, and that is that we don't pay as much attention to the quality of life of cancer patients, their families and those who care for them. We can and must do better. That is the core of the message my colleagues delivered in their article. More...

Are We Ready For Inexpensive, Patient Directed Genetic Testing For Breast Cancer?

by Dr. Len April 21, 2015

Years ago when I first started this blog I wrote about the democratization of information, and how people would come to an era where they had ready access to  information yet reserved  the right to determine whether that information was valid or not.

Fast forward to today, and a company called Color Genomics announced a new genomic based profile to measure breast cancer risk. They are clearly headed into the democratization of health care, since they are pricing the test at $249 and have tried to reduce the barriers for women and men to get the test.

Inevitably, this announcement is going to fan the flames of how far we should be going to allow people to get whatever laboratory tests they would like, whenever they want them. Although a health professional must order the test, in reality doctors will be available to meet your need if you decide to bypass your personal physician. And although most professional organizations active in this field recommend genetic counseling from a qualified professional be done  before such tests are done, the company says they will provide such counseling-after the test results are known. More...

Is It Time For Precision/Personalized Medicine?

by Dr. Len January 30, 2015

This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.

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Are we prepared for the genomics revolution?

The President's proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it's probably time to get ready for some changes in our daily routines as health professionals.

I'm not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.

And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.

No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It's not just about cancer, my friends. It will be coming to a primary care practice near you probably sooner than you realize -- but it is coming. More...

CanceRX 2014: We Need Innovative Approaches To Support Cancer Drug Development

by Dr. Len November 06, 2014

What if you were sitting in the room with some of the best financial and scientific minds in the country and someone asked how many of you would be willing to contribute a modest sum of money to create a company with the potential of speeding up the evaluation of drugs that could revolutionize cancer treatment?

That was the opening question of a fascinating meeting I attended recently at the Massachusetts Institute of Technology, one where I didn't want to leave my seat for a moment for fear I would miss another thought-provoking comment or idea.

The meeting was called CanceRX 2014, and for two solid days about 300 participants listened, debated, and engaged in discussion on how to make that scenario happen. No small task, to be certain. But in this era of ever increasing research discoveries of new treatment targets, it is clear that we need some innovative thinking to take what we learn in the laboratory to the bedsides of the patients we care for. And to make that happen we need as much "out of the box" thinking as we can muster. More...

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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